Transcript

1.
____________________________________________________________________________
Purchasing Services
REQUEST FOR PROPOSAL (RFP)
TITLE: FORMS MANAGEMENT SERVICES FOR UMDNJ,
UNIVERSITY HOSPITAL
RFP NUMBER: P06-129(S)
DATE ISSUED: 8/3/06
DUE DATE: 8/31/06
TIME: 2:00 P.M.
LOCATION: UNIVERSITY OF MEDICINE AND DENTISTRY OF NEW JERSEY
DEPARTMENT OF PURCHASING SERVICES
LIBERTY PLAZA
335 George Street, 2nd Floor
New Brunswick, New Jersey 08903
Important Note: Bidders should check Section 1.3 of this document to
verify if attendance at a mandatory event (e.g., pre-bid conference, site visit,
etc.) is required for this procurement. Failure to attend a mandatory event will
result in the rejection of your proposal.
In accordance with the requirements of this proposal, the undersigned offers and agrees, if their proposal is accepted,
to furnish any and all services for which the prices are submitted in accordance with the attached conditions as
specified in this proposal.
BIDDER’S NAME SIGNATURE AND TITLE OF
AND ADDRESS AUTHORIZED INDIVIDUAL
_________________________
Name (signature)
_________________________
Name (print)
_________________________
Title

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1.0 INFORMATION FOR BIDDERS
1.1 Purpose and Intent of the Procurement
1.1.1 Purpose
This Request for Proposal (RFP) is being issued by the University of Medicine and Dentistry of
New Jersey (UMDNJ), Department of Purchasing Services on behalf of the UMDNJ, University
Hospital.
The purpose of this RFP is to enter into a contract to provide a “Forms Management Program”
for the University of Medicine and Dentistry of New Jersey (UMDNJ).
1.1.2 Intent
It is the University’s intent to award this contract to one firm who will be responsible for meeting
the charge of the engagement as outlined in Section 3, Scope of Work, of this document.
1.2 Background
University Hospital is a 500-bed facility with usage of over 400 forms in all areas of the hospital,
including the Doctors Office Center (DOC), the clinics, Stanley S. Bergen, Jr. (SSB) building
and Emergency Medical Services (EMS).
Currently there are 350 active forms in the program with an annual dollar volume of
approximately $620,000.00. The Hospital is looking to decrease the annual dollar volume of
forms ordered in the past. The issuance of a contract does not guarantee that a specific amount
of forms will be requested. The Contractor will be required to print, store and deliver Hospital
forms and provide off-site storage and a desktop distribution program.
1.3 Key Events
1.3.1 Questions and Inquiries
It is the policy of the UMDNJ, Purchasing Services to accept questions and inquiries from all
potential bidders receiving this RFP.
Written questions should be mailed or faxed to the UMDNJ, Purchasing Services to the attention
of the assigned buyer at the following address:
UMDNJ, DEPARTMENT OF PURCHASING SERVICES
335 GEORGE STREET, 2ND FLOOR
NEW BRUNSWICK, NEW JERSEY 08903
ATTN: Yvonne Miranda
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Buyer’s Phone Number: 732-235-9089
Buyer’s Fax Number: 732-235-9024
E-mail: mirandyv@umdnj.edu
1.3.1.1 Cut-Off Date for Questions and Inquiries
A mandatory Pre-bid Conference has been scheduled for this procurement; therefore, the cut-off
date for submission of questions will be the conclusion of the mandatory Pre-Bid Conference.
While all questions will be entertained at the mandatory Pre-bid Conference, it is strongly urged
that questions be submitted in writing prior to the mandatory Pre-bid Conference. Written
questions must be delivered to the Department of Purchasing Services’ Buyer. It is requested
that bidders having long, complex or multiple part questions submit them in writing as far in
advance of the mandatory Pre-bid Conference as possible. This request is made so that answers
can be prepared prior to the mandatory Pre-bid Conference.
1.3.1.2 Question Protocol
Questions should be submitted in writing to the attention of the assigned UMDNJ, Purchasing
Services buyer. Written questions should be directly tied to the RFP by the writer. Questions
should be asked in consecutive order, from beginning to end, following the organization of the
RFP. Each question should begin by referencing the RFP page number and section number to
which it relates.
Short procedural inquiries may be accepted by telephone by the buyer; however, oral
explanations or instructions given over the telephone shall not be binding upon the University.
Bidders shall not contact any person within the University directly, in person, or by telephone,
other than the assigned buyer, concerning this RFP.
1.3.2 Mandatory Pre-Bid Conference
A mandatory Pre-Bid Conference has been scheduled for this procurement. The purpose of the
mandatory Pre-Bid Conference is to provide a structured and formal opportunity for bidders to
raise questions and clarify any of the proposal requirements. The date, time and location are
provided as follows:
DATE: August 15, 2006
TIME: 10:00am
LOCATION: UMDNJ, DEPARTMENT OF PURCHASING SERVICES, LIBERTY PLAZA,
335 GEORGE STREET, 2ND FLOOR, NEW BRUNSWICK, NEW JERSEY
CAUTION: Bids will be automatically rejected from any bidder that was not represented or
failed to properly register at the Mandatory Pre-bid Conference.
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It is the responsibility of the bidder to identify and address any additional requirements or
information needed to submit a proposal. No special consideration shall be given to any bidder,
because of the bidder's failure to be knowledgeable of all the requirements of the proposal after
the pre-bid conference date.
1.4 Additional Information for Bidders
1.4.1 Revisions to this RFP
In the event that it becomes necessary to clarify or revise this RFP, such clarification or revision
will be by addendum. Any RFP addendum will be distributed as follows:
Since a mandatory Pre-Bid Conference has been scheduled for this procurement, any addendum
issued before the mandatory Pre-Bid Conference will be distributed to all bidders who were sent
the initial RFP. Any addendum issued at the time of or after the mandatory Pre-Bid Conference
will be distributed only to those bidders represented and properly registered at the mandatory
Pre-Bid Conference.
1.4.2 Addendum as a Part of this RFP
Any addendum to this RFP shall become part of this RFP and part of any contract resulting from
this RFP.
1.4.3 Issuing Office
This RFP is issued by the UMDNJ, Department of Purchasing Services. The buyer noted in
Section 1.3.1 is the sole point of contact between the bidder and the UMDNJ for purposes of this
RFP.
1.4.4 Bidder Responsibility
The bidder assumes sole responsibility for the complete effort required in this RFP. No special
consideration shall be given after bids are opened because of a bidder’s failure to be
knowledgeable of all the requirements of this RFP. By submitting a proposal in response to this
RFP, the bidder represents that it has satisfied itself, from its own investigation, of all the
requirements of this RFP.
1.4.5 Cost Liability
UMDNJ assumes no responsibility and bears no liability for costs incurred by bidders in the
preparation and submittal of proposals in response to this RFP.
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1.4.6 Contents of Bid Proposal
The entire content of every bid proposal will be publicly opened and becomes a public record.
This is the case notwithstanding any statement to the contrary made by a bidder in its bid
proposal.
All bid proposals, as public records, are available for public inspection. Interested parties can
make an appointment to inspect bid proposals received in response to this RFP with the buyer.
1.4.7 Price Alterations
Bid prices must be typed or written in ink. Any price changes (including "white-outs") must be
initialed. Failure to initial price changes may preclude an award being made to the bidder.
1.4.8 Joint Venture
If a joint venture is submitting a bid, the agreement between the parties relating to such joint
venture should be submitted with the joint venture’s proposal. Authorized signatories from each
party comprising the joint venture must sign the bid proposal. A separate Ownership Disclosure
Form, Affirmative Action Employee Information Report, MacBride Principles Certification and,
if applicable, foreign (out of State) corporate registration must be supplied for each party to the
joint venture.
1.4.9 HIPAA Compliance
As a State Agency, New Jersey State regulations require that we obtain documentation regarding
our vendor “HIPAA Compliance” status. In order to be in compliance and conduct business with
your company for the procurements of goods and/or services, it will be necessary for your
company to complete a Business Associate Agreement. This agreement involves the access to
protected health information that is considered protected pursuant to federal, state and/or local
laws and regulations in accordance with the privacy requirements of the “HIPAA” – Health
Insurance Portability and Accountability Act of 1996. The requirement is a precondition of
entering into a valid and binding contract.
1.4.10 Business Registration Notice
All New Jersey and out of State business organizations must obtain a Business Registration
Certificate (BRC) from the Department of the Treasury, Division of Revenue, prior to
conducting business with the State of New Jersey. Proof of valid business registration must be
submitted by a bidder with its bid proposal. Failure to submit such valid business registration
with a bid will render the bid materially non-responsive. The business registration form (Form
NJ-REG) can be found online at: http://www.state.nj.us/treasury/purchase/busreg.htm
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1.4.10.1 Definitions
For the purpose of the section, the following shall be defined as follows:
“Affiliate” means any entity that (1) directly, indirectly, or constructively controls another entity,
(2) is directly, indirectly, or constructively controlled by another entity, or (3) is subject to the
control of a common entity. An entity controls another entity if it owns, directly or individually,
more than 50% of the ownership in that entity.
“Business organization” means an individual, partnership, association, joint stock company,
trust, corporation, or other legal business entity or successor thereof.
“Business registration” means a business registration certificate issued by the Department of the
Treasury or such other form or verification that a Contractor or subcontractor is registered with
the Department of Treasury.
“Contractor” means a business organization that seeks to enter, or has entered into, a contract to
provide goods or services with a contracting agency.
“Contracting agency” means the principal departments in the Executive Branch of the State
Government, and any division, board, bureau, office, commission or other instrumentality within
or created by such department, or any independent State authority, commission, instrumentality
or agency, or any State college or university, any county college, or any local unit.
“Subcontractor” means any business organization that is not a Contractor that knowingly
provides goods or performs services for a Contractor or another subcontractor in the fulfillment
of a contract.
1.4.10.2 Requirements Regarding Business Registration Form
A Contractor shall submit a copy of its business registration at the time of submission of its bid
proposal in response to this RFP.
A subcontractor shall provide a copy of its business registration to any Contractor who shall
forward it to the contracting agency. No contract with a subcontractor shall be entered into by
any Contractor unless the subcontractor first provides proof of valid business registrations.
The Contractor shall provide written notice to all subcontractors that they are required to submit
a copy of their business registration to the Contractor. The Contractor shall maintain a list of the
names of any subcontractors and their current addresses, updated as necessary during the course
of the contract performance. The Contractor shall submit to the contracting agency a copy of the
list of subcontractors, updated as necessary during the course of performance of the contract.
The Contractor shall submit a complete and accurate list of the subcontractors to the contracting
agency before a request for final payment is made to the using agency.
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The Contractor and any subcontractor providing goods or performing services under the contract,
and each of their affiliates, shall, during the term of the contract, collect and remit to the Director
of the Division of Taxation in the Department of Treasury the use tax due pursuant to the “Sales
and Use Tax Act, P.L. 1966, c. 30 (N.J.S.A. 54:32B-1 et seq.) on all their sales of tangible
personal property delivered into the State.
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2.0 DEFINITIONS
The following definitions shall be part of any contract awarded or order placed as a result of this
RFP:
“Addendum” – Written clarification or revision to this RFP issued by UMDNJ, Purchasing
Services.
“Amendment” – A change in scope of work to be performed by the Contractor. An amendment
is not effective until it is signed by the Vice President for Finance and Treasurer.
“Bidder” – An individual or business entity submitting a bid in response to this RFP.
“Contract” – This RFP, any addendum to this RFP, and the bidder’s proposal submitted in
response to this RFP and UMDNJ’s Contract Term Sheet.
“Contractor” – The Contractor is the bidder awarded a contract.
“Evaluation Committee” – A committee established to review and evaluate bid proposals
submitted in response to this RFP and to recommend a contract award to the Executive Director,
Materials Management.
“Executive Director” – The Executive Director, Materials Management; the contracting officer
of UMDNJ.
“F.O.B. Destination” – the title of the goods passes to the buyer when the goods arrive at their
destination. The distinction is important because it determines who pays for the shipping costs of
the merchandise: whoever holds the title to the merchandise at the time of its shipping pays for
its transportation costs..
“HIPAA” – Health Insurance Portability and Accountability Act of 1996.
“May” – Denotes that which is permissible, not mandatory.
“Project” – The undertaking of services that are the subject of this RFP.
“Request for Proposal (RFP)” – This document, which establishes the bidding and contract
requirements and solicits proposals to meet the purchase needs as identified herein.
“Shall” or “Must” – Denotes that which is a mandatory requirement. Failure to meet a
mandatory requirement will result in the rejection of a bid proposal as materially non-responsive.
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“Should” – Denotes that which is recommended, not mandatory.
“Subtasks” – Detailed activities that comprise the actual performance of a task.
“Task” – A discrete unit of work to be performed.
“UMDNJ” – The University of Medicine and Dentistry of New Jersey, or otherwise referred to
as the “University.”
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3.0 SCOPE OF WORK
3.1 The Contractor must purchase the University’s forms inventory from the previous
Contractor and assume full responsibility for storage and distribution. Payment in full is
expected at the time the forms are transferred to the Contractor’s warehouse. Failure to
comply with this requirement will result in cancellation of the contract. The current retail
value of the inventory is estimated at approximately $215,000.00. (Inventory to be
verified upon award)
3.2 The Contractor must pickup, warehouse and distribute the University’s forms inventory
at no additional charge to the University, from the current Contractor upon written
notification of payment by the University to the current Contractor. Additionally, the
Contractor will assume full responsibility for storage and distribution of the forms at no
extra cost to the University.
3.3 The Contractor must make available an account representative on an as needed basis, to
review the account, propose problem resolutions, provide design consultation, and
recommend cost reduction opportunities, all at no additional charge. In addition, the
account representative will be required to attend monthly Forms Committee meetings and
all other meetings pertaining to the services provided.
3.4 Emergency orders must be delivered within 24 hours of request. Normal deliveries must
be delivered within 72 hours of request.
3.5 If the Contractor makes a mistake on a printed form, the Contractor is responsible for all
corrections and deliveries, at no additional cost. The Contractor shall deliver replacement
orders within 72 hours.
3.6 UMDNJ only authorizes the production of 3-6 months supply of forms at one time to be
determined by University Hospital, except as provided for in section 3.7.1 below. The
Contractor will be responsible for storing the forms at its warehouse and providing
delivery at least two (2) times per week and/or on an as needed basis.
3.6.1 In year three (3) of the contract, the Contractor will make every attempt to dramatically
reduce the inventory. The Contractor must not produce more than a 3 month supply of
forms at a time during the third year of the contract.
3.7 Prior to the production of any forms, the Contractor is responsible for meeting with
departmental representatives to discuss whether or not the form requires revisions or
should remain the same. The Contractor must obtain the approval of the Forms
Committee prior to production of any revised forms.
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3.8 Regardless of whether or not the form requires revisions, the Contractor is responsible for
obtaining the written approval of the requesting department via a Reprint Notice Form
prior to reproduction, and maintain file copies of all Reprint Notices. The Contractor
must provide a Reprint Status Report to the Director of Medical Records or his/her
designee and to the Forms Committee on a monthly basis.
3.9 UMDNJ is financially liable for all forms in the Contractor’s warehouse, but payment
will only be made to the Contractor after the forms are delivered to UMDNJ. At the
termination of the agreement, UMDNJ will be financially liable for all forms in the
Contractor’s warehouse at that time.
3.10 UMDNJ will render payment within sixty (60) days after the contract is officially
terminated and said forms are either delivered to UMDNJ or to the awarded Contractor’s
warehouse.
3.11 The Contractor is required to use recycled paper for the production of all forms and
provide reports detailing the quantity and dollar volume of forms produced on recycled
paper.
3.12 The Contractor must furnish the Director of Medical Records with an inventory sheet
showing the supply on hand in the warehouse on a monthly basis; this will be due the
15th of every month.
3.13 Reports
The Contractor shall provide monthly management reports as outlined:
• Detailed Utilization Report
• Summary Utilization Report
• Inventory Status Report
• Reprint Status Report
• Open Order Status Report
• Budget Status Report
3.14 The Contractor must submit a Monthly Summary Billing Statement, with supporting
documentation.
3.15 The Contractor must provide a desktop delivery distribution program, which includes
direct delivery to all requisitioning departments between normal business hours. The
desktop delivery system means the Contractor will deliver directly to the requisitioning
department, obtain a signature and approval for each delivery, and provide a summary
bill monthly. Copies must be given to Medical Records to receive the forms in the
Hospital Pipeline System and allow the Hospital to pay the Contractor.
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Deliveries will be made on the Newark campus. If other campus locations require forms,
delivery will be made from the Newark campus. Deliveries may also be made to the
Piscataway/New Brunswick campuses, as requested.
3.16 The Contractor must provide a 3-part packing slip with each delivery. The packing slip
shall be noted as follows:
• Part 1 – Contractor Copy
• Part 2 – Requisitioners Copy
• Part 3 – Medical Records - Billing
Note: The Contractor must deliver Parts 2 and 3 of the packing slip for each delivery to
the Medical Records Director or his/her designee at the end of each delivery day.
3.17 The Contractor must maintain an electronic database of all hospital forms to be accessible
by specified hospital personnel. Forms should be posted to this database in PDF format.
4.0 SPECIAL CONTRACTUAL TERMS AND CONDITIONS
4.1 Contract Term and Extension Option
4.1.1 Contract Term
The contract will be awarded for three years, commencing from the date of award. If delays in
the bid process result in an adjustment of the anticipated contract effective date, the bidder agrees
to accept a contract for the full term of the contract.
4.1.2 Contract Extension Option
This contract may be extended for a fourth and/or fifth option year period. Any extension of this
contract under this provision will be put into effect by mutual agreement between the University
and the Contractor, with written notification being provided to the Contractor by the University.
The original terms and conditions will remain in effect for any extension period.
4.2 Contract Transition
In the event services end by either contract expiration or termination, it shall be incumbent upon
the Contractor to continue services, if requested by the Executive Director, Materials
Management, until new services can be completely operational. The Contractor acknowledges
its responsibility to cooperate fully with the replacement Contractor and UMDNJ to ensure a
smooth and timely transition to the replacement Contractor. Such transitional period shall not
extend more than ninety (90) days beyond the expiration date of the contract, or any extension
thereof. The Contractor will be reimbursed for services during the transitional period at the rate
in effect when the transitional period clause is invoked by UMDNJ.
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4.3 Precedence of the University’s Standard Terms and Conditions
The contract resulting from this procurement shall consist of this RFP (including UMDNJ’s
Standard Terms and Conditions); any addendum to this RFP, the Contractor’s bid proposal and
UMDNJ’s Contract Term Sheet.
Unless specifically noted within this RFP, UMDNJ’s Standard Terms and Conditions take
precedence over the Special Terms and Conditions contained in this Section of the RFP. The
Standard Terms and Conditions in effect for this procurement can be found at the following
Internet address: www.umdnj.edu/purchweb
The version of the Standard Terms and Conditions that apply to this procurement is as follows:
1) If a mandatory event is conducted as part of this procurement (e.g., mandatory pre-bid
conference, mandatory site visit, etc.), the Standard Terms and Conditions that apply to
this procurement are those that are posted on the Web site referenced above on the
business day prior to the mandatory event; or,
2) If no mandatory event is conducted as part of this procurement, yet an addendum is
issued (e.g., in response to questions from bidders), the Standard Terms and Conditions
that apply to this procurement are those that are posted on the Web site referenced
above on the business day prior to the date of issuance of the addendum; or,
3) If no mandatory event is conducted and no addendum is issued for this procurement, the
Standard Terms and Conditions that apply to this procurement are those that are posted
on the Web site referenced above on the business day prior to the bid opening date.
In the event of a conflict between the provisions of this RFP, including UMDNJ’s Standard
Terms and Conditions and the Special Terms and Conditions contained in this Section, and any
addendum to the RFP, the addendum shall govern.
In the event of a conflict between the provisions of this RFP, including any addendum to this
RFP, and the bidder’s proposal, the RFP and/or the addendum shall govern.
4.4 Contract Amendment
Any changes or modifications to the terms of the contract shall only be valid when they have
been reduced to writing and executed by the Contractor and the Executive Director, Materials
Management.
4.5 Contractor Responsibilities
The Contractor shall have sole responsibility for the complete effort specified in the contract.
Payment will be made only to the Contractor. The Contractor shall have sole responsibility for
all payments due any subcontractor.
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The Contractor is responsible for the professional quality, technical accuracy and timely
completion and submission of all deliverables, services or commodities required to be provided
under the contract. The Contractor shall, without additional compensation, correct or revise any
errors, omissions, or other deficiencies in its deliverables and other services. The approval of
deliverables furnished under this contract shall not in any way relieve the Contractor of
responsibility for the technical adequacy of its work. The review, approval, acceptance or
payment for any of the services shall not be construed as a waiver of any rights that UMDNJ
may have arising out of the Contractor’s performance of this contract.
4.6 Substitution of Staff
If it becomes necessary for the Contractor to substitute any management, supervisory or key
personnel, the Contractor will identify the substitute personnel and the work to be performed.
The Contractor must provide detailed justification documenting the necessity for the substitution.
Résumés must be submitted evidencing that the individual(s) proposed as substitution(s) have
qualifications and experience equal to or better than the individual(s) originally proposed or
currently assigned.
The Contractor shall forward a request to substitute staff to the Executive Director, Materials
Management, through the University’s Project Manager, for consideration and approval. No
substitute personnel are authorized to begin work until the Contractor has received written
approval to proceed from the Executive Director, Materials Management, through the
University’s Project Manager.
4.7 Substitution or Addition of Subcontractor(s)
If it becomes necessary for the Contractor to substitute and/or add a subcontractor, the
Contractor will identify the proposed new subcontractor and the work to be performed. The
Contractor must provide detailed justification documenting the necessity for the substitution or
addition.
The Contractor must provide detailed résumés of the proposed subcontractor’s management,
supervisory and other key personnel that demonstrate knowledge ability and experience relevant
to that part of the work, which the subcontractor is to undertake.
In the event a subcontractor is proposed as a substitution, the proposed subcontractor must equal
or exceed the qualifications and experience of the subcontractor being replaced. In the event the
subcontractor is proposed as an addition, the proposed subcontractor’s qualifications and
experience must equal or exceed that of a similar subcontractor proposed by the Contractor in its
bid proposal.
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The Contractor shall forward a request to substitute/add a subcontractor to the Executive
Director, Materials Management, through the University’s Project Manager, for consideration
and approval. No substitution or addition of a subcontractor is authorized until the Contractor
has received written approval to proceed from the Executive Director, Materials Management,
through the University’s Project Manager.
4.8 Ownership of Material
All data, technical information, materials gathered, oriented, developed, prepared, used or
obtained in the performance of the contract, including, but not limited to, all reports, surveys,
plans, charts, literature, brochures, mailings, recordings (video and/or audio), pictures, drawings,
analyses, graphic representations, software computer programs and accompanying
documentation and print-outs, notes and memoranda, written procedures and documents,
regardless of the state of completion, which are prepared for or are a result of the services
required under this contract shall be and remain the property of UMDNJ and shall be delivered to
UMDNJ upon 30 days notice by UMDNJ.
With respect to software computer programs and/or source codes developed for UMDNJ, the
work shall be considered “work for hire,” i.e., UMDNJ, not the Contractor or subcontractor, shall
have full and complete ownership of all software computer programs and/or source codes
developed.
4.9 Data Confidentiality
All financial, statistical, personnel and/or technical data supplied by UMDNJ to the Contractor
are confidential. The Contractor is required to use reasonable care to protect the confidentiality
of such data. Any use, sale or offering of this data in any form by the Contractor, or any
individual or entity in the Contractor’s charge or employ, will be considered a violation of this
contract and may result in contract termination and the Contractor’s suspension or debarment
from UMDNJ contracting. In addition, such conduct may be reported to the State Attorney
General for possible criminal prosecution.
4.10 News Releases
The Contractor is not permitted to issue news releases pertaining to any aspect of the services
being provided under this contract without prior written consent of the Executive Director,
Materials Management.
4.11 Advertising
The Contractor shall not use UMDNJ’s name, logos, images, or any data or results arising from
this contract as a part of any commercial advertising without first obtaining the prior written
consent of the Executive Director, Materials Management.
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4.12 License and Permits
The Contractor shall obtain and maintain in full force and effect all required licenses, permits,
and authorizations necessary to perform this contract. The Contractor shall supply UMDNJ with
evidence of all such licenses, permits and authorizations. This evidence shall be submitted
subsequent to the contract award. All costs associated with any such licenses, permits and
authorizations shall have been included by the Contractor its bid proposal.
4.13 Claim and Remedies
4.13.1 Claims
The following shall govern claims made by the Contractor regarding contract award recision,
contract interpretation, Contractor performance and/or suspension or termination.
Final decisions concerning all disputes relating to contract award recision, contract interpretation
Contractor performance and/or reduction, suspension or termination are to be made in a manner
consistent with N.J.A.C. 17:12-1.1, et seq. The Executive Director, Materials Management’ final
decision shall be deemed a final agency action reviewable by the Superior Court of New Jersey,
Appellate Division.
All claims asserted against UMDNJ by the Contractor shall be subject to the New Jersey Tort
Claims Act, N.J.S.A. 59:1-1, et seq., and/or the New Jersey Contractual Liability Act, N.J.S.A.
59:13-1, et seq.
However, any claim against UMDNJ relating to a final decision by the Executive Director,
Materials Management regarding contract award recision, contract interpretation, Contractor
performance and/or contract reduction, suspension or termination shall not accrue, and the time
period for performing any act required by N.J.S.A. 59:8-8 or 59:13-5 shall not commence, until a
decision is rendered by the Superior Court of New Jersey, Appellate Division (or by the Supreme
Court of New Jersey, if appealed) that such final decision by the Executive Director, Materials
Management was improper.
4.13.2 Remedies
Nothing in the contract shall be construed to be a waiver by UMDNJ of any warranty, expressed
or implied, or any remedy at law or equity, except as specifically and expressed stated in writing
executed by the Executive Director, Materials Management.
4.14 Form of Compensation and Payment
The Contractor must submit monthly invoices in triplicate to UMDNJ with supporting
documentation evidencing forms have been distributed. Invoices must reference the purchase
order number and must be in strict accordance with the firm, fixed prices submitted on the RFP
pricing sheet. All invoices must be approved by UMDNJ before payment will be authorized.
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4.15 Additional Work and/or Special Projects
The Contractor shall not begin performing any additional work or special projects without first
obtaining written approval from the Executive Director, Materials Management.
In the event that the need for additional work and/or a special project arises, UMDNJ will submit
such a request to the Contractor in writing. The Contractor must present a written proposal to
perform the additional work/special project to UMDNJ. The proposal should provide
justification for the necessity of the additional work/special project. The relationship between
the additional work/special project being requested and the work required by the Contractor
under the base contract must be clearly established by the Contractor in its proposal for
performing the additional work/special project. The Contractor’s written proposal must provide
a detailed description of the work to be performed, broken down by task and subtask. The
proposal should contain details on the level of effort, including hours, labor categories, etc.,
necessary to compete the additional work.
The written proposal must detail the cost necessary to complete the additional work in a manner
consistent with the contract. The written cost proposal must be based upon the hourly rates, unit
costs or other cost elements submitted by the Contractor in the Contractor’s original bid proposal
submitted in response to this RFP. Whenever possible, the cost proposal should be a firm, fixed
cost performs the required work. The firm fixed price should specifically reference and be tied
directly to costs submitted by the Contractor in its original bid proposal. A payment schedule,
tied to successful completion of tasks and subtasks, must be included.
Upon receipt of the Contractor’s written proposal, it shall be forwarded to the Executive
Director, Materials Management for written approval. Complete documentation from the using
agency, confirming the need for the additional work/special project, must be submitted.
No additional work and/or special project may commence without the Executive Director,
Materials Management’s written approval. In the event the Contractor proceeds with additional
work and/or special projects without the written approval of the Executive Director, Materials
Management, it shall be at the Contractor’s sole risk. UMDNJ shall be under no obligation to
pay for work done without the Executive Director, Materials Management’s written approval.
4.16 Option to Reduce Scope of Work
UMDNJ has the option, in its sole discretion, to reduce the scope of work for any task or subtask
called for under this contract. In such an event, the Executive Director, Materials Management
shall provide advanced, written notice to the Contractor.
Upon receipt of such written notice, the Contractor will submit, within five (5) working days to
the Executive Director, Materials Management, an itemization of the work effort already
completed by task or subtasks. The Contractor shall be compensated for such work effort
according to the applicable portions of its cost proposal.
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18.
4.17 Suspension of Work
The Executive Director, Materials Management may, for valid reason, issue a stop order
directing the Contractor to suspend work under the contract for a specific time. The Contractor
shall be paid until the effective date of the stop order. The Contractor shall resume work upon
the date specified in the stop order, or upon such other date as the Executive Director, Materials
Management may thereafter direct in writing. The period of suspension shall be deemed added
to the Contractor’s approved schedule of performance. The Executive Director, Materials
Management and the Contractor shall negotiate and equitable adjustment, if any, to the contract
price.
4.18 Change in Law
Whenever an unforeseen change in applicable law or regulation affects the services that are the
subject of this contract, the Contractor shall advise the Executive Director, Materials
Management in writing and include in such written transmittal any estimated increase or
decrease in the cost of its performance of the services as a result of such change in law or
regulation. The Executive Director, Materials Management and the Contractor shall negotiate an
equitable adjustment, if any, to the contract price.
4.19 Licenses and Permits
The Contractor shall obtain and maintain in full force and effect all required licenses, permits,
and authorizations necessary to perform this contract. The Contractor shall supply the
University's Project Manager with evidence of all such licenses, permits and authorizations. This
evidence shall be submitted subsequent to the contract award, in the event that it had not been
required as part of the Contractor’s bid.
4.20 Requirements of PL 2005, Chapter 51 (Formerly Executive Order 134)
In order to safeguard the integrity of State government procurement by imposing restrictions to
insulate the award of State contracts from political contributions that pose the risk of improper
influence, purchase of access, or the appearance thereof, Executive Order 134 was signed on
September 22, 2004 (EO 134). Pursuant to the requirements of EO 134, the terms and conditions
set forth in this section are material terms of any contract resulting from this RFP:
4.20.1 Definitions
For the purpose of the section, the following shall be defined as follows:
a) Contribution – means a contribution reportable as a recipient under “The New Jersey
Campaign Contributions and Expenditures Reporting Act.” P.L. 1973, c. 83 (C.10:44A-1 et
seq.), and implementing regulations set forth at N.J.A.C. 19:25-7 and N.J.A.C. 19:25-10.1 et seq.
Currently, contributions in excess of $400 during a reporting period are deemed “reported” under
these laws. As of January 1, 2005, that threshold will be reduced to contributions in excess of
$300.
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19.
b) Business Entity – means any natural or legal person business corporation, professional
services corporation, limited liability company, partnership, limited partnership, business trust,
association or any other legal commercial entity organized under the laws of New Jersey or any
other state or foreign jurisdiction. It also includes (i) all principals who own or control more than
10 percent of the stock in the case of a business entity that is a corporation for profit, as
appropriate ; (ii) any subsidiaries directly or indirectly controlled by the business entity; (iii) any
political organization organized under 26 U.S.C.A. 527 that is directly or indirectly controlled by
the business entity, other than a candidate committee, election fund, or political party committee;
and (iv) if a business entity is a natural person, that person’s spouse or child, residing therewith.
4.20.2 Breach of Terms of Executive Order 134 Deemed Breach of Contract
It shall be a breach of terms of the contract for the Business Entity to (i) make or solicit a
contribution in violation of this Order, (ii) knowingly conceal or misrepresent a contribution
given or received; (iii) make or solicit contributions through intermediaries for the purpose of
concealing or misrepresenting the source of the contribution; (iv) make or solicit any
contribution on the condition or with the agreement that is will be contributed to a campaign
committee or any candidate of holder of the public office of Governor, or to any State or county
party committee;
(v) engage or employ a lobbyist or consultant with the intent or understanding that such lobbyist
or consultant would or solicit any contribution, which if made or solicited by the business entity
itself, would subject that entity to the restrictions of EO 134; (vi) fund contributions made by
third parties, including consultants, attorneys, family members, and employee; (vii) engage in
any exchange of contributions to circumvent the intent of EO 134; or (viii) directly or indirectly
through or by any other person or means, do any act which would subject that entity to the
restriction of EO 134.
4.20.3 Certification and Disclosure Requirements
a) The University shall not enter into a contract to procure from any Business Entity services or
any material, supplies or equipment, where the value of the transaction exceeds $17,500, if that
Business Entity has solicited or made any contribution of money or pledge of contribution,
including in-kind contributions to a candidate committee and/or election fund of any candidate
for or holder of the public office of Governor, or to any State or county political party committee
during certain specified time periods. Accordingly, the Business Entity shall submit with its bid
proposal Executive Order 134 Certification in the form set forth in Section 9.0, Form DPP 134-
C&D, certifying that no contributions prohibited by Executive Order 134 have been made by the
Business Entity. A separate Certification is required for each person or organization defined
above as a Business Entity. Failure to submit the Certificate(s) with the Bid Proposal shall
be cause for automatic rejection of the bid proposal.
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20.
b) Prior to awarding any contract or agreement to any Business Entity, the Business Entity, the
Business Entity proposed as the intended awardee of the contract shall report all contributions
the Business Entity made during the preceding four years to any political organization organized
under 26 U.S.C.527 if the Internal Revenue Code that also meets the definition of a “continuing
political committee” within the mean of N.J.S.A. 19:44A-3(n) and N.J.A.C. 19:25-1.7, in the
form of the Disclosure attached hereto in Section 9.0, Form DPP 134-C&D. A separate
Disclosure is required for each person or organization defined above as a Business Entity. Upon
receipt of a Notice of Intent to Award a Contract, the intended awardee shall submit to the
University Buyer, the Disclosure(s) within five (5) business days of the University’s request.
c) Further, the Contractor is required, on a continuing basis, to report any contributions it makes
during the term of the contract, and any extension(s) thereof, at the time any such contribution is
made. A copy of the Continuing Disclosure of Political Contributions is attached hereto in
Section 9.0, Form DPP 134-CD.
4.20.4 State Treasurer Review
The State Treasurer or his designee shall review the Disclosures submitted pursuant to this
section, as well as any other pertinent information concerning the contributions or reports thereof
by the intended awardee, prior to award, or during the term of the contract, by the Contractor. If
the State Treasurer determines that any contribution or action by the Contractor constitutes a
breach of contract that poses a conflict of interest in the awarding of the contract under this
solicitation the State Treasurer shall disqualify the Business Entity from award of such contract.
4.21 New Jersey Election Law Enforcement Commission Requirement
The Contractor is advised of its responsibility to file an annual disclosure statement on political
contributions with the New Jersey Election Law Enforcement Commission (ELEC), pursuant to
N.J.S.A. 19:44A-20.13 (P.L. 2005, c.271, section 3) if the Contractor receives in excess of
$50,000 from a public entity in a calendar year. It is the Contractor’s responsibility to determine
if filing is necessary. Failure to so file can result in the imposition of financial penalties by
ELEC. Additional information about this requirement is available from ELEC at 888-313-3532
or at www.elec.state.nj.us.
5.0 PROPOSAL PREPARATION AND SUBMISSION INSTRUCTIONS
5.1 General
The bidder must follow instructions contained in this RFP and in the bid cover sheet in preparing
and submitting its bid proposal. The bidder is advised to read thoroughly and to follow all
instructions.
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21.
The information required to be submitted in response to this RFP has been determined to be
essential in the bid evaluation and contract award process. Any qualifying statements made by
the bidder to the RFP’s requirements could result in a determination that the bidder’s proposal is
materially non-responsive. Each bidder is given wide latitude in the degree of detail it elects to
offer or the extent to which plans, designs, systems, processes and procedures are revealed. Each
bidder is cautioned, however, that insufficient detail may result in a determination that the bid
proposal is materially non-responsive or, in the alternative, may result in a low technical score
being given to the bid proposal.
The bidder is instructed to clearly identify any requirement of this RFP that the bidder cannot
satisfy.
5.2 Proposal Delivery and Identification
In order to be considered a bid proposal must arrive at the Department of Purchasing Services in
accordance with the instructions on the RFP cover sheet. Bidders submitting proposals are
cautioned to allow adequate delivery time to ensure timely delivery of proposals. UMDNJ
regulations mandate that late proposals are ineligible for consideration. The exterior of all bid
proposal packages must be labeled with the Request for Proposal identification number, final bid
opening date and the buyer’s name.
5.3 Number of Bid Proposal Copies
Each bidder must submit one (1) complete original bid proposal, clearly marked as the
“ORIGINAL” bid proposal. Each bidder should also submit five (5) full, complete and exact
copies of the original. The copies required are necessary in the evaluation of the bid. It is
suggested that the bidder make and retain a complete copy of its bid proposal.
5.4 Proposal Form and Content
The proposal should follow the format indicated in the following Sections of this RFP. The
bidder should limit their response to one volume, if at all possible, with that volume divided into
three (3) sections as indicated below.
5.5 Section 1 – Forms
5.5.1 Ownership Disclosure Form
The bidder must complete the attached Ownership Disclosure Form. A complete Ownership
Disclosure Form must be received prior to, or accompanying, the bid. Failure to do so will
preclude the award of a contract.
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22.
5.5.2 MacBride Principles Certification
The bidder must complete the attached MacBride Principles Certification evidencing compliance
with the MacBride Principles. Failure to do so may result in the award of the contract to another
bidder.
5.5.3 Affirmative Action
The bidder must complete the attached Affirmative Action Employees Information Report, or, in
the alternative, supply either a New Jersey Affirmative Action Certificate, or evidence that the
bidder is operating under a Federally approved or sanctioned affirmative action program. The
requirement is a precondition of entering into a valid and binding contract.
5.5.4 Set-Aside Contracts
Since this procurement is set-aside for small businesses, the bidder should provide evidence with
its bid proposal of certification as a small business from Commerce, or, in the alternative;
evidence that is has registered with Commerce as a small business at least one day prior to the
proposal due date.
5.5.6 Business Associate Agreement
The bidder must complete the attached Business Associate Agreement, involving the access to
protected health information that is considered protected pursuant to federal, state and/or local
laws and regulations in accordance with the privacy requirements of the “HIPAA” – Health
Insurance Portability and Accountability Act of 1996. The requirement is a precondition of
entering into a valid and binding contract.
5.5.7 Business Registration Notice
All New Jersey and out of State business organizations must obtain a Business Registration
Certificate (BRC) from the Department of the Treasury, Division of Revenue, prior to
conducting business with the State of New Jersey. Proof of valid business registration must be
submitted by a bidder with its bid proposal. Failure to submit such valid business registration
with a bid will render the bid materially non-responsive. The business registration form (Form
NJ-REG) can be found online at:
http://www.state.nj.us/treasury/revenue/gettingregistered.htm#busentity
5.5.8 PL 2005, Chapter 51 (Formerly Executive Order 134) Forms
Bidders are reminded of the provisions contained in Section 4 of this RFP, entitled
“Requirements of Executive Order 134,” specifically those pertaining to the forms that are
required to be submitted by this Order. This Section reads, in part:
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23.
“Accordingly, the Business Entity shall submit with its bid proposal Executive Order 134
Certification in the form set forth in Section 9.0, Form DPP 134-POFW, certifying that no
contributions prohibited by Executive Order 134 have been made by the Business Entity. A
separate Certification is required for each person or organization defined above as a Business
Entity. Failure to submit the Certificate(s) with the Bid Proposal shall be cause for
automatic rejection of the bid proposal.”
5.6 Section 2 - Technical and Organizational Support and Experience Proposals
Bidders must submit their technical and organizational support and experience proposals by fully
and accurately completing the Bidder Data Sheets included in this RFP as Section 7.0.
All prices quoted are to be F. O. B. UMDNJ, Newark Campus.
A bidder's failure to fully, properly and accurately complete all of the technical proposal and
organizational support and experience information required by Section 7.0 of the RFP may result
in their bid being considered non-responsive.
5.7 Section 3 - Cost Proposal
5.7.1 Bidders must submit their cost proposal in accordance with the Price Sheet(s) included in
this RFP as Section 8.0.
Failure to submit all information required will result in your bid being considered non-
responsive. Each bidder is requested to hold its prices firm for a minimum of one hundred
twenty (120) days so that an award can be made.
5.7.2 Each bidder should also provide a comprehensive listing of all labor categories that may be
used to perform additional work and/or special projects or according to the additional work
and/or special project clause(s) of this RFP. Loaded hourly rates are to be submitted for all labor
categories that the bidder anticipates may be required to perform additional work and/or special
projects.
Failure to include a labor category along with a loaded hourly rate will exclude that category
from eligibility to perform additional work and/or special projects under the contract resulting
from this RFP. Each bidder may submit labor categories for additional work that are not
included in the base proposal to perform the Scope of Work required by this RFP.
Each bidder may also submit any additional price or cost information that the bidder feels may
be required to perform any additional work and/or special projects required by this RFP.
ONLY price and costing information provided by the bidder in its original bid proposal
submitted in response to this RFP may later be used for additional work and/or special projects to
be paid against the contract resulting from this RFP.
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24.
Given the unpredictability of the demand for forms, coupled with the ever-changing regulatory
environment of healthcare, forms prices shall not assume or include “grouping” or “combos”.
Each form shall be priced based on the merits of the six (6) month volume indicted.
All forms pricing shall be inclusive of costs for forms design and analysis, typesetting, storage,
delivery, production of proofs, copy changes and author alterations, emergency deliveries, etc.
There shall be no additional costs for any services performed by the bidder under this request, for
changes to any forms during the life of the contract. UMDNJ/University Hospital shall not be
financially liable for any costs other than those indicated in the pricing of the forms.
6.0 PROPOSAL EVALUATION AND CONTRACT AWARD
6.1 Proposal Evaluation Committee
Proposals may be evaluated by an Evaluation Committee composed of members of affected
departments together with representative(s) from the Department of Purchasing Services.
Representatives from other governmental agencies may also serve on the Evaluation Committee.
On occasion, the Evaluation Committee may choose to make use of the expertise of an outside
consultant in an advisory role.
6.2 Oral Presentation and/or Clarification of Bids
A bidder may be required to give an oral presentation to the Evaluation Committee concerning
its bid proposal. The Evaluation Committee may also require a bidder to submit written
responses to questions regarding its bid.
The purpose of such communication with a bidder, either through an oral presentation or a letter
of clarification, is to provide an opportunity for the bidder to clarify or elaborate on its bid. The
original bid, as submitted, however, cannot be supplemented, changed, or corrected in any way
during the evaluation process. No comments regarding other bids are permitted. Bidders may
not attend presentations made by their competitors.
It is within the Evaluation Committee’s discretion whether to require a bidder to give an oral
presentation or require a bidder to submit written responses to questions regarding its bid.
Action by the Evaluation Committee in this regard should not be construed to imply acceptance
or rejection of a bid. The Purchasing Services’ buyer is the sole point of contact regarding any
request for an oral presentation or written clarification.
6.3 Evaluation Criteria
The following evaluation criteria categories, not necessarily listed in order of significance, will
be used to evaluate bid proposals received in response to this RFP. The evaluation criteria
categories may be used to develop more detailed evaluation criteria to be used in the evaluation
process.
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25.
6.3.1 The bidder’s Distribution Program.
6.3.2 The bidder’s detailed approach and plans to perform the services required by the Scope of
Work Section of this RFP.
6.3.3 The bidder’s documented experience in successfully providing forms management
services of a similar size and scope of those required by this RFP.
6.3.4 The overall ability of the bidder to mobilize, undertake and successfully provide the
forms management services.
6.3.6 The bidder’s cost proposal.
6.4 University’s Right to Consider Additional Information
6.4.1 The Executive Director may obtain any information determined to be appropriate
regarding the ability of the bidder to supply and/or render the service required by this RFP.
6.4.2 The Executive Director may consider such other factors that, in the opinion of the
Executive Director, are important in evaluating the bidder's proposal and awarding contracts as
determined to be in the best interest of the University.
6.4.3. The University reserves the right to request all bidders to explain the method used to
arrive at any or all cost or pricing figures.
6.4.4 When making the contract award decision, the University may consider evidence of
formal or other complaints against any bidder(s) by the University for contracts held in the past
or present by the bidder.
6.4.5 The University reserves the right to check the bidder's financial capacity and ability to
successfully undertake and complete the services required by this RFP by any means deemed
appropriate.
6.4.6 The University reserves the right to conduct site inspections of any facility(s) serviced by
the bidder(s) to assist in judging the bidder's ability to provide the services required by this RFP.
This applies to all facilities services by the bidder or any sub-Contractor to the bidder. This right
extends to all facilities of which the University is aware, or about which it becomes aware, that
the bidder is servicing, whether or not the facility is listed in the bidder's proposal.
6.5 Contract Award
The contract shall be awarded with reasonable promptness by written notice to that responsible
bidder whose bid, conforming to the invitation for bids, will be most advantageous to UMDNJ,
price and other factors considered. Any or all bids may be rejected when the Executive Director
determines that it is in the public interest to do so.
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26.
7.0 BIDDER’S DATA SHEETS (FORMS TO BE COMPLETED BY BIDDER)
The bidder should fully complete and submit the following Bidder’s Data Sheets. Failure to
satisfactorily complete and submit the Bidder’s Data Sheets may result in a determination that
your bid is non-responsive, resulting in rejection of your bid.
Bidders are strongly advised to use the Bidder’s Data Sheets supplied herein. The bidder should
make additional copies, if necessary.
7.1 BIDDER’S GEAR-UP AND TRANSITION PLAN
All bidders, including any present or incumbent Contractor(s) should submit a detailed gear-up
and transition plan with their bid proposal. The plan should be designed to show the University
that the bidder would be able to establish complete and satisfactory contract operation on the
contract beginning date.
The bidder should show how they plan to make an orderly and efficient transition from the
current contract to complete and satisfactory delivery of all services required by the new
contract. The Gear-Up and Transition Plan should provide for an orderly and efficient start-up.
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27.
7.1.1 Gear-Up and Transitional Timetable
Provide the bidder’s gear-up and transitional plan. The plan should include a detailed timetable
for gear-up and transition. The timetable should convince the University that the new contract
will be operational on the contract beginning date required. For evaluation purposes only,
bidders should use a contract award date of 9/1/06 for the beginning of the gear-up and
transitional period. The new contract should begin and be operational of 9/1/06.
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(MAKE ADDITIONAL COPIES OF THIS SHEET, IF NECESSARY)
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30.
7.1.8 Provide any additional information as to how bidder will completely and satisfactorily
provide all of the services or other work elements as detailed in the Scope of Work of this
RFP on the contract start date.
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7.2 LISTING OF POTENTIAL PROBLEMS
The bidder should include below a summary of any areas it anticipates encountering in
implementing or providing the services or other work elements as detailed in the Scope of Work
of this RFP. The bidder should list problems, which the bidder, in its judgment, feels may
become problems. It is important for the bidder to convince the University of its understanding
of, and ability to solve, these problem areas.
1. Potential Problem:
______________________________________________________________________________
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2. Show in a brief narrative that you understand the cause and substance of the potential problem.
Be specific.
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3. Give a specific recommendation on how to address and solve the problem.
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(MAKE ADDITIONAL COPIES OF THIS SHEET, IF NECESSARY)
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7.3 CONTACT INFORMATION
7.3.1 The bidder should provide the location of bidder’s business office that will be responsible
for management of this contract.
Name: ______________________________________________
Address: ______________________________________________
______________________________________________
______________________________________________
Business Phone Number: ( _ )-___-____
Business Fax Number: ( _)-___-____
7.3.2 The bidder should provide the name(s) and phone number(s) of bidding firm’s
management personnel to be contacted if problems or emergencies occur (24 hours per day).
Name: ____________________
Role of this person for this contract: ___________________________
Work Telephone Number: (___)-___-____
Home Telephone Number: (___)-___-____
Name: ____________________
Role of this person for this contract: ___________________________
Work Telephone Number: (___)-___-____
Home Telephone Number: (___)-___-____
Name: ____________________
Role of this person for this contract: ___________________________
Work Telephone Number: (___)-___-____
Home Telephone Number: (___)-___-____
Name: ____________________
Role of this person for this contract: ___________________________
Work Telephone Number: (___)-___-____
Home Telephone Number: (___)-___-____
(MAKE ADDITIONAL COPIES OF THIS SHEET, IF NECESSARY)
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33.
7.3.3 The bidder should list below the name of the individual that may be contacted at all times
if service or information is required from the Contractor by the University.
Name: ______________________________________________
Address: ______________________________________________
______________________________________________
______________________________________________
Role of this person for this contract: ___________________________
Work Telephone Number: ( _ )-___-____
Business Fax Number: ( _ )-___-____
Home Telephone Number: ( _)-___-____
7.3.4 The bidder should list below the name, address and telephone number of the insurance
firm from which it intends to purchase the insurance required for this contract, and a person to
contact at this firm.
Name of Insurance Firm: ______________________________________
Address of Insurance Firm: _____________________________________________
____________________________________________
____________________________________________
Name and telephone number of individual at the insurance company that the University may
contact to verify this information:
Name: _________________________
Telephone Number: ( _ )-___-____
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34.
7.4 BIDDER’S ORGANIZATIONAL CHART
The bidder should provide, using this page, an organizational chart that shows the bidding firm’s
entire organizational structure. The chart should include actual names and titles. The purpose of
this organizational chart is to show the University how the bidder’s contract management and on-
site supervisors proposed for this contract fit into the overall organizational structure.
(MAKE ADDITIONAL COPIES OF THIS SHEET, IF NECESSARY)
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35.
7.5 PROJECT ORGANIZATION CHART
The bidder should provide, using this page, an organizational chart showing the bidder’s
organization for this term contract alone. The term contract organization chart should show the
bidder’s management and on-site supervisor(s) assigned directly to this contract. Show
individuals with their names and titles. If subcontractors are proposed, show the subcontractor’s
management and supervisory personnel with name and titles.
(MAKE ADDITIONAL COPIES OF THIS SHEET, IF NECESSARY)
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7.6 LISTING OF BIDDER’S MANAGEMENT AND SUPERVISORY PERSONNEL
The bidder should provide a complete list of all contract management and on-site supervisory
personnel to be assigned to this contract by the bidder. The bidder should also include
subcontractor personnel, if applicable. This list should identify the position/title of each
individual assigned and provide a summary of each individual’s function and role in the contract.
1. NAME OF INDIVIDUAL ASSIGNED: _____________________
2. POSITION/TITLE ON THIS CONTRACT: ______________________
3. PROPOSED FUNCTION/ROLE ON THIS CONTRACT:
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______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
1. NAME OF INDIVIDUAL ASSIGNED: _____________________
2. POSITION/TITLE ON THIS CONTRACT: ______________________
3. PROPOSED FUNCTION/ROLE ON THIS CONTRACT:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________________
Request for Proposal: Forms Management Services (RFP #P06-129(S))
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39.
7.7 RESUMES FOR BIDDER’S PERSONNEL ASSIGNED TO THIS CONTRACT
The bidder should provide a detailed resume for each contract manager to be assigned to this
contract as listed in Section 7.7, above. Resumes submitted should also correspond directly to
the chart provided in response to Section 7.6.
NOTE: The bidder should submit at least one (1) acceptable resume for the bidder’s contract
manager. The bidder should submit at least two (2) acceptable resumes for bidder’s on-site
supervisor(s).
Resumes should emphasize the relevant qualifications and experience of the individuals assigned
in successfully providing services similar in size and scope to those required by this RFP. A
description of the contract given as a reference should be provided and should show how the
individual’s work under the contract relates to the services required by this RFP.
Bidders are strongly urged to utilize the format specified below:
_____________________________________________________________________________________
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40.
7.7.1 RESUME FORM: CONTRACT MANAGER(S)
TITLE OR POSITION PROPOSED FOR THIS CONTRACT: _______________________
EMPLOYEE’S NAME: _____________________________________
YEARS EMPLOYED BY YOUR FIRM: _____________
CURRENT POSITION WITH YOUR FIRM: ____________________________________
TOTAL YEARS WORKED IN THE INDUSTRY PROVIDING SERVICES REQUIRED BY
THIS RFP: _____________
EMPLOYMENT DATA: PROVIDE ONLY INFORMATION RELATED TO PRIOR
EMPLOYMENT IN THE INDUSTRY PROVIDING SERVICES REQUIRED BY THIS RFP:
1. EMPLOYER NAME: ______________________________________________
ADDRESS: ________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
NAME OF EMPLOYER’S MANAGEMENT PERSON THAT THE UNIVERSITY MAY
CONTACT TO VERIFY THIS REFERENCE: __________________________________
PHONE NUMBER OF INDIVIDUAL LISTED ABOVE: ( )-___-____
DATES EMPLOYED: FROM _________ TO _________
LIST TOTAL NUMBER OF EMPLOYEES MANAGED: ______
PROVIDE A BRIEF DESCRIPTION OF DUTIES AT THIS JOB. EMPHASIZE DUTIES
THAT ARE SIMILAR TO THOSE REQUIRED BY THIS RFP: ________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
(RESUME FORM: CONTRACT MANAGER(S) CONTINUED ON FOLLOWING SHEET)
_____________________________________________________________________________________
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41.
2. EMPLOYER NAME: ______________________________________________
ADDRESS: ________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
NAME OF EMPLOYER’S MANAGEMENT PERSON THAT THE UNIVERSITY MAY
CONTACT TO VERIFY THIS REFERENCE: __________________________________
PHONE NUMBER OF INDIVIDUAL LISTED ABOVE: ( )-___-____
DATES EMPLOYED: FROM _________ TO _________
LIST TOTAL NUMBER OF EMPLOYEES MANAGED: ______
PROVIDE A BRIEF DESCRIPTION OF DUTIES AT THIS JOB. EMPHASIZE DUTIES
THAT ARE SIMILAR TO THOSE REQUIRED BY THIS RFP: ________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
3. EMPLOYER NAME: ______________________________________________
ADDRESS: ________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
NAME OF EMPLOYER’S MANAGEMENT PERSON THAT THE UNIVERSITY MAY
CONTACT TO VERIFY THIS REFERENCE: __________________________________
PHONE NUMBER OF INDIVIDUAL LISTED ABOVE: ( )-___-____
DATES EMPLOYED: FROM _________ TO _________
LIST TOTAL NUMBER OF EMPLOYEES MANAGED: ______
PROVIDE A BRIEF DESCRIPTION OF DUTIES AT THIS JOB. EMPHASIZE DUTIES
THAT ARE SIMILAR TO THOSE REQUIRED BY THIS RFP: ________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
(RESUME FORM: CONTRACT MANAGER(S) CONTINUED ON FOLLOWING SHEET)
_____________________________________________________________________________________
Request for Proposal: Forms Management Services (RFP #P06-129(S))
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43.
7.8 REFERENCES OF FIRM
The bidder should list references that clearly demonstrate the bidder’s proven capabilities in
performing services of a similar size and scope to those required by this RFP. It is requested that
references be given in the format below.
The bidder should provide a comprehensive listing of contracts requiring work of a similar size
and scope to those required by this RFP. References provided should be for work that has been
successfully undertaken and completed by the bidder. These references will serve as a
demonstration of the firm’s ability to successfully undertake and provide the services required by
this RFP. A description of the contract should be included and should show how the referenced
contract relates to the ability of the firm to provide the services required by this RFP.
1. NAME OF COMPANY PROVIDED AS A REFERENCE FOR YOUR FIRM:
________________________________________________________________
ADDRESS: ________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
NAME OF COMPANY’S MANAGEMENT PERSON THAT THE UNIVERSITY MAY
CONTACT TO VERIFY REFERENCE: _______________________________________
PHONE NUMBER OF INDIVIDUAL LISTED ABOVE: ( )-___-____
DATES UNDER CONTRACT: FROM _________ TO _________
PROVIDE A BRIEF DESCRIPTION OF SERVICES THAT YOUR FIRM PROVIDED FOR
THIS COMPANY UNDER CONTRACT. EMPHASIZE SERVICES THAT ARE SIMILAR
TO THOSE REQUIRED BY THIS RFP:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________________
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44.
2. NAME OF COMPANY PROVIDED AS A REFERENCE FOR YOUR FIRM:
________________________________________________________________
ADDRESS: ________________________________________________________________
___________________________________________________________________________
NAME OF COMPANY’S MANAGEMENT PERSON THAT THE UNIVERSITY MAY
CONTACT TO VERIFY REFERENCE: _______________________________________
PHONE NUMBER OF INDIVIDUAL LISTED ABOVE: ( )-___-____
DATES UNDER CONTRACT: FROM _________ TO _________
PROVIDE A BRIEF DESCRIPTION OF SERVICES THAT YOUR FIRM PROVIDED FOR
THIS COMPANY UNDER CONTRACT. EMPHASIZE SERVICES THAT ARE SIMILAR
TO THOSE REQUIRED BY THIS RFP:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
3. NAME OF COMPANY PROVIDED AS A REFERENCE FOR YOUR FIRM:
________________________________________________________________
ADDRESS: ________________________________________________________________
___________________________________________________________________________
NAME OF COMPANY’S MANAGEMENT PERSON THAT THE UNIVERSITY MAY
CONTACT TO VERIFY REFERENCE: _______________________________________
PHONE NUMBER OF INDIVIDUAL LISTED ABOVE: ( )-___-____
DATES UNDER CONTRACT: FROM _________ TO _________
PROVIDE A BRIEF DESCRIPTION OF SERVICES THAT YOUR FIRM PROVIDED FOR
THIS COMPANY UNDER CONTRACT. EMPHASIZE SERVICES THAT ARE SIMILAR
TO THOSE REQUIRED BY THIS RFP:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________________
Request for Proposal: Forms Management Services (RFP #P06-129(S))
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45.
4. NAME OF COMPANY PROVIDED AS A REFERENCE FOR YOUR FIRM:
________________________________________________________________
ADDRESS: ________________________________________________________________
___________________________________________________________________________
NAME OF COMPANY’S MANAGEMENT PERSON THAT THE UNIVERSITY MAY
CONTACT TO VERIFY REFERENCE: _______________________________________
PHONE NUMBER OF INDIVIDUAL LISTED ABOVE: ( )-___-____
DATES UNDER CONTRACT: FROM _________ TO _________
PROVIDE A BRIEF DESCRIPTION OF SERVICES THAT YOUR FIRM PROVIDED FOR
THIS COMPANY UNDER CONTRACT. EMPHASIZE SERVICES THAT ARE SIMILAR
TO THOSE REQUIRED BY THIS RFP:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
5. NAME OF COMPANY PROVIDED AS A REFERENCE FOR YOUR FIRM:
________________________________________________________________
ADDRESS: ________________________________________________________________
___________________________________________________________________________
NAME OF COMPANY’S MANAGEMENT PERSON THAT THE UNIVERSITY MAY
CONTACT TO VERIFY REFERENCE: _______________________________________
PHONE NUMBER OF INDIVIDUAL LISTED ABOVE: ( )-___-____
DATES UNDER CONTRACT: FROM _________ TO _________
PROVIDE A BRIEF DESCRIPTION OF SERVICES THAT YOUR FIRM PROVIDED FOR
THIS COMPANY UNDER CONTRACT. EMPHASIZE SERVICES THAT ARE SIMILAR
TO THOSE REQUIRED BY THIS RFP:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
(MAKE ADDITIONAL COPIES OF THESE SHEETS, IF NECESSARY)
_____________________________________________________________________________________
Request for Proposal: Forms Management Services (RFP #P06-129(S))
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46.
7.9 LISTING OF ALL CONTRACTS LOST IN LAST THREE (3) YEARS
The bidder should provide a complete list of all contracts the bidder has lost or has had
terminated during the last three (3) years, along with the reason why each one was lost or
terminated. Include the name of a contact person and phone number for each contract lost or
terminated.
1. NAME OF FIRM: ___________________________________
NAME OF CONTACT PERSON AT FIRM: ________________________________
PHONE NUMBER OF CONTACT PERSON: _______________________________________
REASON FOR TERMINATION: _________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
2. NAME OF FIRM: ___________________________________
NAME OF CONTACT PERSON AT FIRM: ________________________________
PHONE NUMBER OF CONTACT PERSON: _______________________________________
REASON FOR TERMINATION: _________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
3. NAME OF FIRM: ___________________________________
NAME OF CONTACT PERSON AT FIRM: ________________________________
PHONE NUMBER OF CONTACT PERSON: ______________________________________
REASON FOR TERMINATION: _________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
_____________________________________________________________________________________
Request for Proposal: Forms Management Services (RFP #P06-129(S))
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48.
7.10 SUBCONTRACTOR DATA SHEET(S)
If the bidder is proposing to use subcontractors, the following information should be completed
and submitted with your bid.
NOTE: If there is more than one (1) subcontractor, bidders should submit the following data for
each subcontracting firm. It is suggested that bidders make blank copies of this section and
complete a copy for each subcontractor.
1. PROVIDE SUBCONTRACTOR’S NAME, ADDRESS, CONTACT PERSON AND
24-HOUR PHONE NUMBER:
FIRM NAME: ____________________________________
ADDRESS: _________________________________________________________________
___________________________________________________________________________
CONTACT PERSON: ______________________________
24-HOUR PHONE NUMBER: ________________________________
2. LIST BELOW THE NAME(S), TITLE(S) AND FUNCTION(S), OF THE RESPONSIBLE
OPERATING OFFICERS:
NAME TITLE FUNCTION
____________________ __________________ __________________
____________________ __________________ __________________
____________________ __________________ __________________
____________________ __________________ __________________
____________________ __________________ __________________
3. SPECIFY, IN DETAIL, THE FUNCTION(S) THE SUBCONTRACTOR WILL BE
PERFORMING:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________________
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49.
(SUBCONTRACTOR DATA SHEET (CONTINUED))
4. INDICATE BELOW THE SUBCONTRACTOR’S EXPERIENCE IN PERFORMING
SIMILAR SERVICES TO THOSE REQUIRED BY THIS RFP:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
5. NAME AND ADDRESS, CONTACT NAME AND TELEPHONE NUMBER OF FIRM
PROVIDED AS A REFERENCE FOR SUBCONTRACTOR:
NAME OF COMPANY PROVIDED AS A REFERENCE FOR THE SUBCONTRACTOR:
________________________________________________________________
ADDRESS: ________________________________________________________________
___________________________________________________________________________
NAME OF COMPANY’S MANAGEMENT PERSON THAT THE UNIVERSITY MAY
CONTACT TO VERIFY REFERENCE: _______________________________________
PHONE NUMBER OF INDIVIDUAL LISTED ABOVE: ( )-___-____
DATES UNDER CONTRACT: FROM _________ TO _________
PROVIDE A BRIEF DESCRIPTION OF SERVICES THAT THE SUBCONTRACTOR
PROVIDED FOR THIS COMPANY UNDER CONTRACT. EMPHASIZE SERVICES THAT
ARE SIMILAR TO THOSE REQUIRED BY THIS RFP:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________________
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50.
(SUBCONTRACTOR DATA SHEET (CONTINUED))
NAME OF COMPANY PROVIDED AS A REFERENCE FOR THE SUBCONTRACTOR:
________________________________________________________________
ADDRESS: ________________________________________________________________
___________________________________________________________________________
NAME OF COMPANY’S MANAGEMENT PERSON THAT THE UNIVERSITY MAY
CONTACT TO VERIFY REFERENCE: _______________________________________
PHONE NUMBER OF INDIVIDUAL LISTED ABOVE: ( )-___-____
DATES UNDER CONTRACT: FROM _________ TO _________
PROVIDE A BRIEF DESCRIPTION OF SERVICES THAT THE SUBCONTRACTOR
PROVIDED FOR THIS COMPANY UNDER CONTRACT. EMPHASIZE SERVICES THAT
ARE SIMILAR TO THOSE REQUIRED BY THIS RFP:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
NAME OF COMPANY PROVIDED AS A REFERENCE FOR THE SUBCONTRACTOR:
________________________________________________________________
ADDRESS: ________________________________________________________________
___________________________________________________________________________
NAME OF COMPANY’S MANAGEMENT PERSON THAT THE UNIVERSITY MAY
CONTACT TO VERIFY REFERENCE: _______________________________________
PHONE NUMBER OF INDIVIDUAL LISTED ABOVE: ( )-___-____
DATES UNDER CONTRACT: FROM _________ TO _________
PROVIDE A BRIEF DESCRIPTION OF SERVICES THAT THE SUBCONTRACTOR
PROVIDED FOR THIS COMPANY UNDER CONTRACT. EMPHASIZE SERVICES THAT
ARE SIMILAR TO THOSE REQUIRED BY THIS RFP:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
(MAKE ADDITIONAL COPIES OF THESE SHEETS, IF NECESSARY)
_____________________________________________________________________________________
Request for Proposal: Forms Management Services (RFP #P06-129(S))
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51.
7.11 BIDDER’S FINANCIAL CAPACITY
The bidder should provide proof of the firm’s financial capacity and capabilities to undertake and
successfully provide services required under this contract. A financial statement for the most
recent fiscal year or bank reference is acceptable. The University reserves the right to check and
evaluate the firm’s financial capacity and capability by any means deemed appropriate. The
submission of this information with the bid is desired by the University, but is not mandatory.
However, if a bidder chooses not to include this information with its bid, this information may be
requested from the bidder during the evaluation process. If the bidder is requested to submit this
information during the evaluation process, the bidder will be required to submit it, and failure to
do so will be cause for finding the bid non-responsive. Attach information to this form.
_____________________________________________________________________________________
Request for Proposal: Forms Management Services (RFP #P06-129(S))
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68.
OWNERSHIP DISCLOSURE FORM
INSTRUCTIONS: Provide below the names, home addresses, dates of birth, offices held and any ownership interest of all officers of the firm
named above. If addition space is necessary, provide on an attached sheet.
Name Home Address Date of Birth Office Held Ownership Interest
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
INSTRUCTIONS: Provide below the names, home addresses, dates of birth, and ownership interest of all individuals not listed above, and any
partnerships, corporations and any other owner having a 10% or greater interest in the firm named above. If a listed owner is a corporation or
partnership, provide below the same information for the holders of 10% or more interest in that corporation or partnership. If additional space is
necessary, provide that information on any attached sheet. If there are no owners with 10% or more interest in your firm, enter “None” below.
Complete the certification at the bottom of this form. If this form has previously been submitted to the UMDNJ, Purchasing Department in
connection with another bid, indicate changes, if any, where appropriate, and complete the certification below.
Name Home Address Date of Birth Office Held Ownership Interest
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
COMPLETE ALL QUESTIONS BELOW
Within the past five years has another company or corporation had a 10% or greater interest in the firm identified above? (If yes complete and
attach a separate disclosure form reflecting previous ownership interests.) Yes _____ No _____
Has any person listed in this form or its attachments ever been arrested, charged, indicted, plead guilty or been convicted in a criminal or
disorderly persons matter by the State of New Jersey, any other Political subdivision state or the U.S. Government? (If yes, attach a detailed
explanation for each instance.) Yes _____ No _____
Has any person or entity listed in this form or its attachments ever been excluded suspended, debarred or otherwise declared ineligible by any
agency of government from bidding or Contracting to provide services, labor, material or supplies? (If yes, attach a detailed explanation for each
instance.) Yes _____ No _____
Are there now any criminal matters, suspension or debarment proceedings pending in which the firm and/or its officers and/or managers are
involved? (If yes, attach a detailed explanation for each instance.) Yes _____ No _____
Has any federal, state or local license, permit or other similar authorization, necessary to perform the work applied for herein and held or applied
for by any person or entity listed in this form, been suspended or revoked, or been the subject of any pending proceedings specifically seeking or
litigating the issue of suspension or revocation? (If yes to any part of this question, attach a detailed explanation for each instance.) Yes _____
No _____
CERTIFICATION: I, being duly sworn upon my oath, hereby represent and state that the foregoing information and any attachments thereto to
the best of my knowledge are true and complete. I acknowledge that the State of New Jersey is relying on the information contained herein and
thereby acknowledge that I am under a continuing obligation from the date of this certification through the completion of any contracts with the
State to notify the State in writing or any changes to the answers or information contained herein. I acknowledge that I am aware that it is a
criminal offense to make a false statement or misrepresentation, and if I do so, I recognize that I am subject to criminal prosecution under the law
and that it will also constitute a material breach o my agreement(s) with the State of New Jersey and that the State at its option, may declare any
contract(s) resulting from this certification void and unenforceable.
I, being duly authorized, certify that the information supplied above, including all attached pages, is complete and correct to the best of my
knowledge. I certify that all of the foregoing statements made by me are true. I am aware that if any of the foregoing statements made by me are
willfully false, I am subject to punishment. (Print or Type)
Date:_______________________ ________________________________________Signature
________________________________________Name
________________________________________Title
_____________________________________________________________________________________
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69.
NOTICE TO ALL BIDDERS
REQUIREMENT TO PROVIDE A CERTIFICATION
IN COMPLIANCE WITH MACBRIDE PRINCIPLES
AND NORTHERN IRELAND ACT OF 1989
Pursuant to Public Law 1995, c.134, a responsible bidder selected, after public bidding, by the Director of
the Division of Purchase and Property, pursuant to N.J.S.A. 52:34-12, or the Director of the Division of
Building and Construction, pursuant to N.J.S.A. 52-32-2, must complete the certification below by
checking one of the two representations listed and signing where indicated. If a bidder who would
otherwise be awarded a purchase, contract or agreement does not complete the certification, then the
Directors may determine, in accordance with applicable law and rules, that it is in the best interest of the
State to award the purchase, contract or agreement to another bidder who has completed the certification
and has submitted a bid within five (5) percent of the most advantageous bid. If the Directors find
Contractors to be in violation of the principles which are the subject of this law, they shall take such
action as may be appropriate and provided for by law, rule or contract, including, but not limited to,
imposing sanctions, seeking compliance, recovering damages, declaring the party in default and seeking
debarment or suspension of the party.
I certify, pursuant to N.J.S.A. 52:34-12-2, that the entity for which I am authorized to bid:
____ has no ongoing business activities in Northern Ireland and does not maintain a physical presence
therein through the operation of offices, plants, factories or similar facilities, either directly or indirectly
through intermediaries, subsidiaries or affiliated companies over which it maintains effective control; or
____ will take lawful steps in good faith to conduct any business operations it has in Northern Ireland in
accordance wit the MacBride principles of nondiscrimination in employment as set forth in N.J.S.A.
52:18A-89.8 and in conformance with the United Kingdom’s Fair Employment 9Northern Ireland) Act of
1989, and permit independent monitoring of their compliance with those principles.
I certify that the foregoing statements made by me are true. I am aware that if any of the foregoing
statements made by me are willfully false, I am subject to punishment.
____________________________________________ Dated: ______________
Signature of Bidder
____________________________________________
Print or Type Name
____________________________________________
Title
PBMACB 12/95
_____________________________________________________________________________________
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70.
Business Associate Agreement
Involving the Access to Protected Health Information
The following provisions (Amendment) are added and incorporated into the attached Forms
Management Services #P06-129-S (“Agreement”) entered in between UMDNJ- University
Hospital (“Covered Entity”) and __________________________________________________
Name of Contracting Party
(Business Associate), herein collectively referred to as the “Parties”. Any conflict in the terms of
the Agreement and this Amendment shall be governed by the terms of this Amendment.
WHEREAS Covered Entity is the state university of health sciences in New Jersey which
maintains and operates UMDNJ-University Hospital;
WHEREAS Business Associate performs forms management services work which requires it to
have access to confidential health information that is considered protected pursuant to federal,
state and/or local laws and regulations;
WHEREAS Covered Entity desires to protect the confidentiality and integrity of the information
noted above, prevent inappropriate disclosure of such information and comply with all applicable
federal, state and/or local laws and regulations governing the use and disclosure of such
information;
NOW therefore, the parties agree as follows:
1. Confidentiality and Disclosure of Patient Information.
The Parties to this Agreement agree that Business Associate, its agents and employees may have
access to confidential protected health information (“PHI”), including but not limited to
demographic information. As used herein, PHI shall mean individually identifiable health
information, as defined in 45 CFR § 164.501which includes health information that (i) identifies
an individual (or can be used to form a reasonable basis upon which to identify an individual),
(ii) is created or received by a health care provider, health plan, employer, or health care
clearinghouse; (iii) relates to the past, present, or future physical or mental health or condition of
an individual; the provision of health care to an individual; or the past present, or future payment
for the provision of health care to an individual; and (iv) is shared, transmitted or otherwise
communicated between Covered Entity and Business Associate (including subcontractors or
agents of such parties) in connection with this Agreement.
_____________________________________________________________________________________
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71.
The Parties to this Agreement agree that Business Associate:
will not use or further disclose PHI other than as permitted by this Agreement;
will ensure that all transmissions of PHI are authorized and in accordance with the privacy
requirements of the Health Insurance Portability and Accountability Act of 1999, as amended
from time to time (“HIPAA”) and will not use or disclose PHI in a manner that violates or would
violate HIPAA;
will implement administrative, physical and technical safeguards that reasonably and
appropriately protect the confidentiality, integrity, and availability of the Electronic Protected
Health Information that it creates, receives, maintains or transmits on behalf of the Covered
Entity.
will use appropriate safeguards to prevent use or disclosure of the information other than as
provided for by its contract;
will (i) promptly report to Covered Entity any use or disclosure of PHI not provided for by this
Agreement, including but not limited to systems compromises, immediately upon becoming
aware of such unauthorized use or disclosure; (ii) will take all necessary steps to prevent and
limit any further improper or unauthorized disclosure and misuse of such information; and (iii)
indemnify and hold Covered Entity, its directors, officers, agents, and employees harmless from
all liabilities, costs and damages arising out of, or in any manner connected with, the disclosure
by Business Associate, its employees, agents, or independent Contractors; and (iii) permit
Covered Entity to investigate any such report and to examine Business Associate’s premises,
records and premises;
will promptly report to the Covered Entity any security incident of which the Business Associate
becomes aware; a security incident is defined as the attempted or successful unauthorized
access, use, disclosure, modification, or destruction of information or interference with system
operations in an information system.
will ensure that to the extent that the Business Associate it uses one or more agents, including
subcontractors, to provide services under this Agreement, such subcontractors or agents who
receive or have access to PHI that is received from Covered Entity, or created or received by
Business Associate on behalf of Covered Entity, will comply with the same restrictions and
conditions to which Business Associate is bound by entering into a separate written agreement
between Business Associate and its subcontractors to that effect;
will ensure that any agent, including a subcontractor, to whom the Business Associate provides
electronic protected health information, agrees to implement reasonable and appropriate
safeguard to protect the electronic protected health information.
_____________________________________________________________________________________
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72.
will, at the request of, and in the time and manner designated by the Covered Entity, provide
access to the PHI to the Covered Entity or the individual to whom such PHI relates or his or her
authorized representative in order to meet a request by such individual under promptly notify
Covered Entity as required by 45 CFR §164.524;
will, at the request of, and in the time and manner designated by the Covered Entity, incorporate
any and all amendments or corrections to PHI when notified by Covered Entity that such
information is inaccurate or incomplete in accordance with 45 CFR § 164.526;
will, at the request of, and in the time and manner designated by the Covered Entity, provide to
the Covered Entity such information as is requested by the Covered Entity, including but not
limited to current policies and procedures, operational manuals and/or instructions, and/or
employment and/or third party agreements, to permit Covered Entity to respond to a request by
an individual for an accounting of the disclosures of the individual’s PHI in accordance with 45
CFR 528;
will make its internal practices, books and records relating to the use and disclosure of PHI
available to the Secretary of Health and Human Services governmental officers and agencies and
Covered Entity for purposes of determining compliance with 45 CFR §§ 164.500-534; and
will adhere to the Covered Entity’s HIPAA policies and procedures.
Termination for violation of disclosure restrictions. Notwithstanding any other provision of this
Agreement, Covered Entity may terminate this Agreement and any related agreements, without
penalty if Covered Entity determines that Business Associate has violated a material term of this
Agreement’s restrictions, safeguards or requirements relating to the proper use and disclosure of
PHI. Alternatively, Covered Entity may choose to: (i) provide Business Associate with written
notice of the existence of a breach of the terms of this Agreement relating to PHI; and (ii) afford
Business Associate an opportunity to cure such breach upon mutually agreeable terms. In the
event that mutually agreeable terms cannot be achieved within 10 business days, Business
Associate must cure said breach to the satisfaction of the Covered Entity within 10 business
days. Covered Entity may immediately terminate this Agreement for Business Associate’s
failure to cure in the manner set forth in this section.
Return/Destruction of PHI. Business Associate agrees that, upon termination of this Agreement
for any reason, it will if feasible, return or destroy all PHI maintained in any form (including
ensuring the return or destruction of all PHI in the possession of its subcontractors or agents)
received from, or created or received by it on behalf of Covered Entity and retain no copies of
such information. An authorized representative of Business Associate shall certify in writing to
covered Entity, within five (5) days from the date of termination or other expiration of this
Agreement, that all PHI has been returned or disposed of as provided above, (including all PHI
in the possession of its subcontractors or agents) and that neither Business Associate nor its
subcontractors or agents retains any such PHI in any form.
_____________________________________________________________________________________
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73.
No Feasible Return/Destruction of PHI. To the extent that the return or destruction of PHI as
provided for in Section 4 above is not feasible, Business Associate shall extend the precautions
of this Agreement to the information and limit further uses and disclosures to those purposes that
make the return or destruction of the information infeasible. Notwithstanding any other
provision of this Agreement to the contrary, Business Associate shall remain bound and shall
ensure that the provisions of this Agreement, similarly bind its subcontractors and agents even
after termination of this Agreement, until such time as all PHI has been returned or otherwise
destroyed as provided in accordance with this section.
Disclaimer. Covered Entity makes no warranty or representation that compliance by Business
Associate with this Agreement or the HIPAA regulations will be adequate or satisfactory for
Business Associate’s own purposes or that any information in the possession of Business
Associate or control, or transmitted or received by Business Associate, is or will be secure from
unauthorized use or disclosure, nor shall Covered Entity be liable to Business Associate for any
claim, loss or damage relating to the unauthorized use or disclosure of any information received
by Business Associate from Covered Entity or from any other source. Business Associate is
solely responsible for all decisions made by Business Associate regarding the safeguarding of
PHI.
Legal Action. Business Associate agrees that unauthorized disclosure of PHI may give rise to
irreparable injury to the patient or to the owner of such information and accordingly the patient
or owner of such information may seek legal remedies against Business Associate. Business
Associate further agrees that the remedy at law for any breach by it of the terms of this
Agreement shall be inadequate and that the damages resulting from such breach and are not be
susceptible to being measured in monetary terms. Accordingly, in the event of a breach or
threatened breach by Business Associate of the terms of this Agreement, covered Entity shall be
entitled to immediate injunctive relief and may obtain a temporary order restraining any
threatened or further breach. Nothing herein shall be construed as prohibiting Business
Associate from pursuing any other remedies available to Business Associate for such breach or
threatened breach, including recovery of damages from Business Associate. Business Associate
further represents that it understands and agrees that the provisions of this agreement shall be
strictly enforced and construed against it.
Construction. This Agreement shall be construed as broadly as necessary to implement and
comply with HIPAA. The parties agree that any ambiguity in this Agreement shall be resolved
in favor of a meaning that complies and is consistent with HIPAA.
Severability. In the event that any provision of this Agreement violates any applicable statute,
ordinance or rule of law in any jurisdiction that governs this Agreement, such provision shall be
ineffective to the extent of such violation without invalidating any other provision of this
Agreement.
Authority. The persons signing below have the right and authority to execute this Agreement
for their respective entities and no further approvals are necessary to create a binding agreement.
_____________________________________________________________________________________
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74.
Governing Law. This Agreement shall be governed by the laws of the State of New Jersey and
shall be construed in accordance therewith.
Reference: Code of Federal Regulations, Title 45, Part 160 et seq.
IN WITNESS WHEREOF, the parties have executed this Agreement the day and year first
written below.
Covered Entity Business Associate
By: ___________________________ By: ___________________________
Title: __________________________ Title: _________________________
Date: _________________________ Date: _________________________
_____________________________________________________________________________________
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75.
AFFIRMATIVE ACTION DOCUMENTATION
Dear Vendor:
As a State Agency, New Jersey State Regulations N.J.A.C. 17:27 requires us to obtain
documentation regarding our vendors’ “Affirmative Action” status. In order for us to be in
compliance and do business with your company for the procurement of goods and services, it
will be necessary for you to provide only one of the following documents with your bid/proposal
response.
1. A State of New Jersey “Certificate of Employee Information Report Approval,” or
2. A Form AA/302 Affirmative Action Employee Information Report, or
3. A Federal letter of approval from the Department of Labor.
Please understand the importance of this request. Although you may have already submitted this
information, our files must be updated annually with current employment statistics. Your
noncompliance of this request may result in suspension of any future business with your
company.
Sincerely,
Purchasing Services
_____________________________________________________________________________________
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